Multiple Sclerosis

Question 1

what is multiple sclerosis?

Answer 1

Chronic, inflammatory disorder causing demyelination & axonal injury

Question 2

T/F Multiple sclerosis has remissions and exacerbations

Answer 2

True

Question 3

What is lhermitte’s sign?

Answer 3

an electrical shock like sensation that runs down the back or limps upon flexion of the neck

Question 4

what are some symptoms of MS?

Answer 4

sensory in limbs
visual loss
motor
diplopia
gait disturbance
balance problems
sensory in face 
vertigo
bladder problems
lhermitte sign
pain
acute transverse myelopathy 
pain 
polysymptomatic onset

Question 5

What are some diagnostic tests for Ms?

Answer 5

MRI to reveal lesions
Evoked potential test to measure nerve sensations
Lumbar puncture to check for increased WBC’s or proteins

Question 6

what assessments should you conduct on a patient suspicious of MS?

Answer 6

Medical history, and in depth neuro exam

including gait, posture, coordination, balance

Question 7

what patterns are required for diagnosis?

Answer 7

• Two or more episodes of exacerbation (separated by 1 month, lasting longer than 24 hours with subsequent recovery)
• or clinically defined exacerbations & remissions with or without complete recovery, followed by progression of sx over a period of at least 6 months
• or slow and stepwise progression of s and sx

Question 8

what are three goals of therapy of MS?

Answer 8

• modify the disease process
• treat acute relapses
• manage symptoms

Question 9

what are some non-drug interventions?

Answer 9

PT– strengthening exercises, mobility assistance

Counseling– coping strategies for patient and family

Question 10

what are some teaching points for patients?

Answer 10

Self care:
recognize triggers (infection, trauma, stress, change in environment)
-rest
-exercise (regular aerobic)
-avoid extreme heat, keep environment cool (tepid/cool baths)
-well balanced diet, keeps immune system strong
-maintain normal activities
-stay connected
-pursue hobbies
-join support group
-maintain physical health as much as possible

Question 11

pre-procedure for lumbar puncture

Answer 11

• prior to procedure, empty bladder
• lateral recumbent position in fetal position
• tilt table
• consent form

Question 12

patient positioning for lumbar puncture

Answer 12

• may or may not be required to lay flat for 1 hour after procedure
• no evidence to support notion of longer bed rest = less headache

Question 13

what to monitor with lumbar puncture

Answer 13

monitor for spinal headache
–bed rest & analgesics– including opioids

moderate to severe pain:
blood patch and IV caffeine

Question 14

what is an evoked potential test

Answer 14

detection electrodes place on scalp, neck, and back

responses to stimulation are recorded

Question 15

Visual evoked potential test

Answer 15

-sits before a screen in which a checkerboard pattern is displayed to assess visual changes associated with MS

Question 16

Auditory evoked potential test

Answer 16

patient hears a series of clicks in each ear

Question 17

sensory evoked potential test

Answer 17

short electrical impulses are administered to an arm or leg